Recurrent Corneal Erosion Syndrome

Recurrent Corneal Erosion Syndrome refers to repeated episodes of superficial spontaneous corneal abrasions leading to severe eye pain, watering and photophobia (an aversion to lights). Abrasions/erosions are "scratches" on the surface of the cornea, the clear "window" at the front of the eyel. In many cases, the cells of the outer layer of the cornea are loosely attached to the underlying tissue. These cells are lifted off the cornea, typically on waking, leading to recurrent abrasions. Most episodes occur in patients who have previously suffered a corneal abrasion or scratch e.g. after being accidentally poked in the eye by a child's finger.

 

What are the symptoms of Recurrent Corneal Erosion Syndrome?

Patients typically present with attacks of moderate to severe eye pain, redness, tearing, and photophobia (severe light sensitivity). Some patients may report blurring of vision. Most patients report symptoms after waking from sleep.

Are there any risk factors that predispose to the development of Recurrent Corneal Erosion Syndrome?

Recurrent Corneal Erosion Syndrome typically occurs in eyes that have previously suffered a corneal abrasion e.g. from a fingernail. The abrasion heals very quickly, but is prone to recurrent abrasions in the future. Some patients may have an underlying corneal dystrophy that predisposes to recurrent abrasions. Diabetic patients are more prone to the problem.

What is the treatment for Recurrent Corneal Erosion Syndrome?

Treatment is largely preventative and involves a stepwise approach:

  • Aggressive lubrication with artificial tears is recommended combined with a lubricant ointment at bedtime e.g. Hyabak drops during the day and Lacrilube ointment at bedtime.
  • If there is no relief with aggressive lubrication, a therapeutic soft (bandage) contact lens may be used to prevent further abrasions. This specially designed contact lens, which has no optical power, is left on the eye for several weeks without removal in an attempt to prevent further corneal abrasions and promote better healing. Antibiotic drops are used to prevent infections which are a risk with long-term therapeutic contact lens use. Most patients recover completely with aggressive lubrication and/or placement of a bandage contact lens.
  • Anterior stromal puncture consists of making tiny puncture holes in the surface of the cornea to promote stronger attachments between corneal cells and the underlying membrane. This is undertaken in clinic at a slit lamp.
  • Superficial keratectomy: this is performed with either a sterile scalpel blade or using an excimer laser, the same laser used for corneal laser surgery. These treatments help to promote better healing of the abrasion.

Alcohol Delamination is very successful in almost all cases of recurrent corneal abrasion syndrome. This procedure is performed by specialist corneal surgeons and involves applying 20% alcohol to the cornea, removing the abnormal surface and allowing new healthy corneal cells to form.

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